An article that appeared in The New England Journal of Medicine earlier this month is being hailed by the National Association of Chain Drug Stores for helping to drive home the organization’s message that community pharmacists play a key role in helping reduce long-term health care costs.

Research highlights need to improve Rx adherence

NEW YORK – An article that appeared in The New England Journal of Medicine earlier this month is being hailed by the National Association of Chain Drug Stores for helping to drive home the organization’s message that community pharmacists play a key role in helping reduce long-term health care costs.

In the article “Thinking Outside the Pillbox: Medication Adherence as a Priority for Health Care Reform,” Harvard University economics professor David Cutler and Wendy Everett, president of the New England Healthcare Institute (NEHI), write that pharmacies’ role in helping patients take medications correctly is key to improving lives and reducing long-term health care costs.

“Poor adherence to treatment regimens has long been recognized as a substantial roadblock to achieving better outcomes for patients,” the authors state. “Data show that as many as half of all patients do not adhere faithfully to their prescription medication regimens.”

As a result, more than $100 billion a year is spent on avoidable hospitalizations, Cutler and Everett say.

And that spending, they note, is just one aspect of an even larger problem. According to a July 2009 estimate by NEHI, poor medication adherence leads to $290 billion in total annual costs, or 13% of all health care expenditures.

“Poor adherence to treatment regimens has long been recognized as a substantial roadblock to achieving better outcomes for patients,” the authors state. “We’ve known for some time that improved adherence can lead to improvements in health outcomes and reductions in health care spending.”

“Pharmacy plays a critical role in helping patients take the right medications and take them correctly,” remarks NACDS president and chief executive officer Steve Anderson. “As the face of neighborhood health care, pharmacists are uniquely qualified to help patients understand the importance of following their medication regimens properly.
“Working together, pharmacists and patients can improve health care for individuals and for the system overall through reduced costs.”

Cutler and Everett say the evidence is overwhelming that nonadherence to medication regimens affects the quality and length of patients’ lives.

They point to estimates showing that better adherence to anti­hypertensive treatment alone could prevent 89,000 premature deaths in the United States every year. “What is less clear is why adherence to the 3.8 billion prescriptions written every year is so poor,” they write in their article.

While noting that out-of-pocket costs for medication clearly affect adherence — people use more drugs when the prices of the drugs are lower — they argue that even if drugs were free, nonadherence would persist.

One recent study showed that even among patients who have health plans with no cost sharing for medications, rates of nonadherence were nearly 40%, write Cutler and Everett.
A lack of coordination of care is another major factor that drives down compliance, they say.

“There is much more that could be done at the time a physician prescribes a medication to optimize and tailor regimens for individual patients,” the authors say. “For patients with coexisting conditions who take multiple medications prescribed by multiple physicians, there is a vital need to reconcile the prescribed regimen with what a patient is actually taking and to understand why there is a difference between the two.”

Cutler and Everett note, however, that optimizing and reconciling medications require substantial investments of time by a skilled health care practitioner, as well as electronic data sharing among practitioners — neither of which is widely available in the health care system now.

“We’ve known for some time that improved adherence can lead to improvements in health outcomes and reductions in health care spending,” Cutler and Everett say. “What we haven’t known is where to start.

“With the new federal health care reform law moving into implementation, the existing movements toward deployment of HIT [health information technology], improved coordination of care and payment reform together create a desire and an infrastructure for improving health outcomes through improved adherence.”